Methods: A retrospective study was conducted in HIV patients who underwent routine screening for anal cancer from January 2011 to January 2013. hr-HPV test is done concomitantly on anal cytology specimen that was placed in liquid-based ThinPrep (Cytyc, USA) using Hybrid Capture 2 assay (Digene Corporation). Medical records of patients who underwent high resolution anoscopy (HRA) because of abnormal cytology (ASCUS and above) or positive hr-HPV were reviewed.
Results: A total of 221 HIV patients underwent screening with both hr-HPV and anal cytology. Among them, 67% were men (73% MSM vs. 27% heterosexual) and 33% women. hr-HPV was positive in 43% (54% MSM, 28% heterosexual men, 27% women). Anal cytology was abnormal in 39% (48% MSM, 28% heterosexual men, 34% of women). Among 117(53%) patients with abnormal screening test, 27% had both hr-HPV infection and abnormal cytology, 14% had only hr-HPV infection and 13% had only abnormal cytology. Cytology results were normal in 50%, non-diagnostic in 10%, ASCUS in 23%, LSIL in 14% and HSIL in 2%. Among 68 HIV patients who underwent HRA because of either abnormal cytology or hr-HPV infection, 22 patients had AIN2+ (17 were MSM) and all had hr-HPV. None of 14 patients with negative hr-HPV who underwent HRA for abnormal cytology had AIN2+. Among 68 patients who underwent HRA, hr-HPV correlated better with AIN2+ compared to anal cytology (rs=0.35 vs. -0.03).
Conclusion: Anal hr-HPV infection, cytological abnormalities and AIN2+ are prevalent among our cohort of HIV infected heterosexual men and women. We suggest anal cancer screening for all HIV infected patients. In our limited sample, hr-HPV performed better than anal cytology in detecting and ruling out AIN2+.
N. Kini, None
B. Barton, None
M. Wessolossky, None